Prognostication in Hospice Care: Challenges, Opportunities, and the Importance of Functional Status

Predicting life expectancy and providing an end-of-life diagnosis in hospice is very challenging for most clinicians given their generally poor training for this role and limited medical education. End-of-life diagnosis alone is often used to certify hospice appropriateness. It is essential, however, to document good supporting evidence of decline and comorbidities. Functional status can be a helpful criterion prior to hospice admission and during required 90-day certifications.

An 80-year-old male who was diagnosed with Stage IV glioblastoma multiforme was transferred from an acute care hospital to a community living center hospice service for end-of-life care. After 6 months of care, the veteran was able to graduate from hospice and transfer to an adult living facility with minimal care needs.

Recognizing the importance of documenting and using functional scales in individuals receiving hospice care is extremely helpful in prognostication.